What is menopause, really?

How long do menopause symptoms last?

Longer than most people are told. In the SWAN study, hot flushes and night sweats lasted a median of 7.4 years in total, about 4.5 of them after the final period — and more than 11.8 years for women whose symptoms started before or early in perimenopause. Median duration differed by group: about 10.1 years for Black women, 8.9 for Hispanic, 6.5 for white, 5.4 for Chinese and 4.8 for Japanese women.

• 7.4 yearsMedian time with hot flushes and night sweats
• 4.5 yearsOf that falls after the final periodSymptoms don't stop at menopause.
• 11.8 yearsMedian when symptoms began before or early in perimenopause
• ~51Median age of menopause in North America

What changed with the FDA and hormone therapy?

On 10 November 2025 the FDA asked makers of menopausal hormone therapy to change their labels:

• The boxed ("black box") warnings about cardiovascular disease, breast cancer and probable dementia are removed. The dementia warning comes out of the label entirely.
• The boxed warning about endometrial cancer stays, but only on systemic estrogen-only products — estrogen without a progestogen can thicken the uterine lining.
• The boxed advice to use "the lowest effective dose for the shortest amount of time" is removed.
• Labels add that starting systemic therapy for moderate to severe hot flushes can be considered in people under 60 or within 10 years of menopause.
• Cardiovascular and breast cancer risks are still described in the body of the label for systemic products.

The first six updated labels were approved on 12 February 2026, and as of October 2026 the FDA hadn't announced more. Other products are still being updated, so the leaflet in your box may not match yet.

Is hormone therapy safe?

For most healthy people under 60 or within 10 years of their final period, the Menopause Society's 2022 position statement says the benefits outweigh the risks for treating bothersome hot flushes and preventing bone loss. It also says there's no rule that hormone therapy has to stop at a certain age. Risks depend on your age, how long it's been since menopause, your personal history, and the type, dose and route of hormones — which is why this is an individual conversation with your clinician, not a yes or no for everyone.

If you have a uterus, estrogen is paired with a progestogen to protect the uterine lining. If you have a history of endometriosis, see the Endometriosis and menopause page — the advice is different.

What about vaginal estrogen?

Low-dose vaginal estrogen treats the genitourinary syndrome of menopause (dryness, pain with sex, urinary symptoms), and the Menopause Society says an added progestogen isn't recommended with it. Its 2022 statement says vaginal estrogen and non-estrogen treatments for these symptoms can be used at any age and for as long as needed.

What are the non-hormonal options?

The Menopause Society's 2023 statement recommends these for hot flushes:

• Cognitive behavioral therapy (CBT) and clinical hypnosis
• SSRIs and SNRIs — low-dose paroxetine (7.5 mg) was approved by the FDA in 2013 as the first non-hormonal treatment for hot flushes
• Gabapentin
• Fezolinetant (Veozah) — it now carries a boxed warning about rare serious liver injury, so liver blood tests are needed before and during treatment
• Elinzanetant (Lynkuet) — FDA-approved in October 2025, after the statement was published
• Oxybutynin, weight loss, and stellate ganglion block

It does NOT recommend these for hot flushes, because the evidence doesn't support them: supplements and herbal remedies, soy and isoflavones, paced breathing, yoga, exercise, mindfulness, acupuncture, and cannabinoids. Exercise and yoga are still good for your bones, heart, sleep and mood — just don't expect them to stop hot flushes.

What about testosterone?

The only evidence-based use of testosterone for women is for low sexual desire that causes distress (hypoactive sexual desire disorder) after menopause, at doses that keep levels in the normal female range. The 2019 global consensus statement found no shown benefit for wellbeing, mood, bone or muscle, and not enough evidence on memory and thinking.